Physical and Mental Health: self-care working with multi-institutional caseloads

How many times have you taken a sick day in the past 12 months? For you, where is the line between being able to go to work, or having to take the day off?

I know that when I was in full-time, non-therapy employment, it was a relatively easy decision to make; am I able to go to work? But, being a freelance Music Therapist, it’s a completely different scenario for many reasons. Here are some of the questions I’ve asked myself:

Can I physically do my job today

Can I mentally do my job today

Am I contagious / infectious and working with vulnerable people

What will the impact be on my patients if I am unable to see them today

Can I afford to take a day off work

Although I made this list in no particular order, when looking at it I wonder if this is actually the order of priority for me on a subconscious level. I don’t want it to be. Does physical health go at the top of the list?

Physical Health

I think that many of us judge our capacity to do our job on the basis of if we are physically healthy enough to do it. And this is an important question; my job as a Music Therapist is incredibly physically demanding. From the unloading and loading of musical instruments into my car, walking between car parks and rooms weighed down by instruments (two full Ikea bags, one guitar, one piano/keyboard and my handbag is standard!), collecting and returning patients to different rooms or buildings, and the physical nature that sessions sometimes take. I have found myself running around a room in circles banging drums, crawling on the floor playing a kazoo, and all sorts of jumping and dancing! This is one of the reasons that my level of physical fitness is important to me, and something I try to maintain.

If you cannot facilitate or participate in a session to your usual / full physical ability, should you be holding the session?

Mental Health

Now we move on to a delicate subject; mental health. This is where the line between able and unable becomes blurry. We all have lives outside of work, and being a Therapist is no different. But when something in your personal life makes you distracted, emotionally unstable, emotionally unavailable or takes away your ability to make careful, rational decisions should you be seeing your patients? This probably depends on the patient, and the kind of work you are doing with them. This also depends on your ability to do your job when going through something difficult in your personal life. It depends on your personality. As Therapists, we are particularly vulnerable to burnout, or compassion fatigue: http://mtp.oxfordjournals.org/content/31/2/166.abstract. Burnout is a term that describes frustration and exhaustion in health care and social professions caused by excessive demands on their resources (Freudenberger HJ. Staff burn-out. J Soc Issues. 1974;30:159-165) Unsurprisingly, there is little research into burnout in UK Music Therapists, but our neighbours in the caring professions such as nurses and support workers have a lot of literature and research into elements that contribute to burnout. Often it can be difficult to realise when this is happening, or we put this down to other elements within our life or work place. It’s also important to remember that as Therapists we often deal with extremely raw, painful and traumatic content within sessions, and this is very difficult to cope with even when in a good, strong emotional place. We all have different support systems in place; I mentioned physical fitness in the paragraph above and this is something that, for me, is as much for my mental health as for my physical wellbeing. I also think that Music Therapists need to know when to seek extra support from a Personal Therapist, friends, or family, trusted colleagues or Supervisor.

If you cannot be fully present, emotionally available, robust and consistent for your patient, should you be holding the session?

Contagious Illness

I go to approximately 11 clinical locations each week. I see, on average, 46 patients a week in a mixture of individual, paired and group sessions. I work in large schools, nursing homes, community centres, people’s homes and more. I come into contact with a lot of germs! One of my family members recently asked me why I tend to get ill quite a lot, and I answered with the above information. They didn’t question me further! I take every hygiene precaution I can; carry anti-bacterial hand gel, wipes for the instruments, I regularly wash my hands and I don’t see a patient if they have a contagious virus or illness. But we cannot avoid airborne germs unless we wear masks (which I don’t want to do) so this means that my immune system is constantly working hard. We can eat well, take vitamins and look after ourselves, but I think that the fact remains that if you are an independent worker that visits many locations a week and comes into contact with many patients, you are going to pick up viruses more often than your average person.

Every institution has a policy on sickness and infection, but generally if you are suffering from a contagious illness, virus, or have had diarrhoea or vomiting within the last 24 hours you should not attend your place of work.

Cancelling Sessions

Unfortunately, the sensitive nature of our work means that cancelling sessions will probably have a negative impact on our patients. This cannot be avoided, but for many of us it comes with a lot of guilt attached. My supervisor recently pointed out that if we can explore unexpected absence with our patients then it can be very therapeutically useful and important, which is very useful to bear in mind when returning from an absence, and also personally gives me more comfort when the situation arises. This sounds blunt; in the real world, people cancel. People aren’t there when they say they will be. This, however hard we try to stop it, happens in therapy world too, and the Music Therapist and patient can explore it together in the safe, therapeutic relationship we have built. Hopefully this can help our patient develop insight into how it affects them and also assist them with developing coping mechanisms and strategies for dealing with unexpected absences outside of the therapy room too.

Financial impact of cancelling work

Recent statistics from the 2015 survey of Music Therapists carried out by BAMT showed that the majority of practicing Music Therapists in the UK are self-employed and working part time hours. I find that being self-employed has a number of perks; being in control of my caseload, taking leave as necessary and being able to design my own schedule. But there are also some negatives; you don’t get paid if you don’t work being the main one. This is a fairly large negative, considering that it deeply impacts the decision making process on whether you are well enough or able to go to work. Suddenly a nasty head cold becomes a real dilemma: am I contagious? Am I working with people with vulnerable immunity? Am I well enough to go to work and do my job? Can I afford to take a day off? This inevitably impacts on your decision as to whether you will go to work. And maybe you will make the decision to go to work but all for that one reason that you need to get paid. How ethical is this? I would be interested to know people’s responses.

Research on how to look after yourself mentally and physically

There is so much information on the internet that it’s hard to know where to begin! Focusing on burnout for my first piece of research, I typed ‘how to prevent burnout in caring professions’ into Google and it came up with 313,000 results. Clicking on a few search results, themes for preventing emotional burnout started to emerge:

Talk about it. Seek support from others, or a personal Therapist.

Look after yourself: exercise frequently and eat healthily

Put self-care high up on the list of priorities ‘By engaging in self-care, we can assert our right to be well and reintroduce our own needs into the equation’ (socialworker.com see below for the link)

Finally, what I’d really like to focus on is how Music Therapists specifically can help prevent emotional and physical strain. I’d suggest that our profession is unusual in the way that it combines so many physical aspects (loading, unloading, carrying and setting up / down equipment, movement in sessions, continuous and repetitive use of musical instruments) and emotional aspects (being a Therapist, being in a care-giving role, dealing with trauma, facilitating and containing emotional expression and release) as well as the business and administration aspects of the role (setting up work, fitting into the multi-disciplinary team, writing reports, recording incidents or safeguarding protocols, assessing and discharging patients).

How can we, as Music Therapists, create some kind of guidelines for healthy practice taking into account all of the above elements that we work with?

Ellie received her MA in Music Therapy from Roehampton University, and undertook additional training to receive certification as a Neurologic Music Therapist. She is employed by Chiltern Music Therapy and as well as a clinician works as a Supervisor and Manager for the organisation. Ellie has experience of working individually and running groups with adults, older adults, children and infants across a number of health and social care sectors, including learning disabilities, ASD, mental health, brain injury and dementia. Alongside her music therapy work Ellie was previously a Trustee and the Student Liaison Officer for the British Association for Music Therapy.